Elsevier

Journal of Hepatology

Volume 57, Issue 6, December 2012, Pages 1305-1311
Journal of Hepatology

Research Article
Prevalence and risk factors of non-alcoholic fatty liver disease in the elderly: Results from the Rotterdam study

https://doi.org/10.1016/j.jhep.2012.07.028Get rights and content

Background & Aims

The prevalence of non-alcoholic fatty liver disease (NAFLD) appears to increase with age. However, limited data are available concerning the prevalence of NAFLD in the elderly. Our aim was to determine the prevalence and risk factors of NAFLD in an elderly population.

Methods

This study was based on participants in the population-based Rotterdam Study. Each participant was interviewed and had a clinical examination at the research center, including a fasting blood collection, liver ultrasonography, and anthropometric assessment. Ordinal and logistic regression analysis was used to assess associations between covariables and (severity of) NAFLD.

Results

Data from 2811 participants (mean age 76.4 ± 6.0 years) were analyzed. The prevalence of NAFLD was 35.1%. The prevalence of NAFLD decreased with advancing age (p <0.001). In logistic regression analysis, age (OR 0.97; 95% CI 0.95–0.99; p <0.001), total physical activity level (OR 0.98, 95% CI 0.96–0.99; p = 0.005), pack years of smoking (OR 1.01, 95% CI 1.00–1.01; p = 0.02), waist circumference >88 cm for women and >102 cm for men (OR 4.89; CI 4.00–5.96; p <0.001), fasting glucose ⩾100 mg/dl or drug treatment for elevated blood glucose (OR 2.11, 95% CI 1.72–2.59; p <0.001), blood pressure ⩾130/85 mmHg or drug treatment for elevated blood pressure (OR 1.80, 95% CI 1.08–3.01; p = 0.03), and triglycerides ⩾150 mg/dl or treatment with serum lipid reducing agents (OR 1.56, 95% CI 1.28–1.91; p <0.001) were associated with NAFLD.

Conclusions

NAFLD is common in the elderly, although the prevalence decreases with advancing age. Further studies are warranted exploring potential factors contributing to this apparent positive selection effect in the elderly.

Introduction

Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in Western countries in parallel with worsening epidemics of obesity and type II diabetes mellitus. NAFLD has been associated with an increased overall and cardiovascular mortality [1], [2], [3]. It has been projected that NAFLD will be the most common indication for liver transplantation in the next decades. In addition, global prevalence and impact of NAFLD are likely to increase as a result of population aging and increasing prevalence of obesity. Therefore, NAFLD constitutes a relevant public health issue.

The estimated prevalence of NAFLD in the adult general population ranges between 15% and 30% [4], [5], [6], [7], [8]. The prevalence of NAFLD appears to increase with age, especially through the fourth to sixth decade of life [9], [10]. In two large studies, based on cohorts of the Dallas Heart Study and Framingham Heart Study, participants with fatty liver were significantly older than participants without fatty liver [5], [6]. However, these studies only included a small number of participants older than 65 years. Prevalence and risk factors of NAFLD may vary in the elderly, as a result of metabolic changes at old age, including fat redistribution, and mitochondrial dysfunction [11], [12].

The association of obesity, diabetes, dyslipidemia, and insulin resistance with NAFLD has been extensively investigated in adult subjects [5], [6], [13], [14], [15], [16], [17]. These metabolic traits are now well-recognized risk factors for NAFLD. However, fewer data are available concerning the association of NAFLD with some environmental traits, including physical activity and smoking. Regarding the latter, studies have yielded contradictory results [18], [19].

The aim of this study was to determine the prevalence of NAFLD in an elderly population and to generate insight into the association of NAFLD with metabolic risk factors, smoking, physical activity, and markers of liver injury.

Section snippets

Study population

The Rotterdam Study is a large prospective population-based cohort study conducted among elderly inhabitants of Ommoord, a district of Rotterdam, The Netherlands. The rationale and study design had been previously described [20]. The medical ethics committee at Erasmus University of Rotterdam approved the study, and written informed consent was obtained from all participants.

Abdominal ultrasonography was added to the core protocol at the fifth survey of the Rotterdam Study (February

Study population

A total of 3205 participants underwent abdominal ultrasonography. Three hundred ninety-four participants were excluded (excessive alcohol consumption (n = 255), positive HBsAg (n = 3) or anti-HCV (n = 24), use of pharmacological agents historically associated with fatty liver (n = 121)). The total number of eligible study participants was 2811.

General characteristics are shown in Table 1. Sixty percent of the study population consisted of women. Mean age of participants was 76.4 ± 6.0 years (range

Discussion

The present study demonstrated that NAFLD was prevalent in more than one-third of the elderly and showed strong association with metabolic traits, including abdominal obesity, dyslipidemia, and impaired fasting glucose. Furthermore, we observed a decreasing prevalence of NAFLD with advancing age, suggesting a positive selection of the elderly without NAFLD.

This is the first large population-based study to describe the prevalence of, and risk factors for NAFLD in the elderly. Although several

Financial support

The Rotterdam Study is supported by the Erasmus MC University Medical Center and Erasmus University Rotterdam, the Netherlands Organization for Scientific Research (NWO), the Netherlands Organization for Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry of Health, Welfare and Sports, the European Commission (DG XII) and by the Municipality of Rotterdam.

This study was financially

Conflict of interest

The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

Acknowledgements

The authors thank the Rotterdam Study participants and the Rotterdam Study team; they also thank Pauline van Wijngaarden for her assistance in data collection.

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